Provider Demographics
NPI:1740595677
Name:IKWUAZOM, STELLA AZUKA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:AZUKA
Last Name:IKWUAZOM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SPANGLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3719
Mailing Address - Country:US
Mailing Address - Phone:631-422-0698
Mailing Address - Fax:
Practice Address - Street 1:445 SPANGLE DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3719
Practice Address - Country:US
Practice Address - Phone:631-422-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily